Debunking 20/20: The real truth about veterinary medicine

A recent story on ABC’s 20/20 asked this question: "Are some vets out to make a buck selling unnecessary shots, tests and procedures to unsuspecting pet owners?"

We’ve broken down the seven-minute news story into its basic assertions and offer suggestions for how to respond to clients if they come into your practice asking about the report. The advice comes from Dr. Robin Downing, DAAPM, owner of Windsor Veterinary Clinic and the Downing Center for Animal Pain Management in Windsor, Colo.; Dr. Kate Knutson, president of the American Animal Hospital Association and owner of Pet Crossing Animal Hospital and Dental Clinic in Bloomington, Minn; and speaker and consultant Dr. Michael Paul of Magpie Veterinary Consulting.

Their No. 1 piece of advice if clients ask about the story? “Don’t get defensive,” Dr. Paul says. “Clients who mention this aren’t talking about you. Nobody thinks these stories apply to everybody.”

There could even be a silver lining to this “gotcha” piece, Downing says. “The fact that this happens reflects back to us as veterinarians that we’re not doing all we can to pre-emptively educate our clients and the pet-owning public,” she says. “It’s a great opportunity for each of us to identify our weaknesses and be more transparent in the exam room and more informative with clients.”

Here are the report’s claims about veterinarians, followed by the truth you can share with clients:

What the news report says: Veterinarians take advantage of clients’ love for animals by recommending unnecessary shots, tests and procedures to benefit their bottom line

What to say to clients
> “That was a very disappointing report. It was extremely one-sided, and I think, Mrs. Jones, you know me well enough to know that’s not how I operate. The veterinarians I know are dedicated to the relationship between the pet owner and the pet, and we want to offer the best care we can to strengthen that relationship.” (Dr. Paul)

> “We take very seriously our moral imperative to advocate on behalf of animals that cannot advocate for themselves. Because animals can’t answer our questions or point to where it hurts, we veterinarians need to take the initiative in exploring diagnoses and treatments to find out what’s wrong. Many veterinary diseases can be diagnosed with a blood test or urine test long before clinical signs occur. When we see clinical signs, it’s often too late to easily intervene.” (Dr. Downing)

> “My role is to help you make a care assessment for your dog or cat based on your goals for your pet’s health and your pet’s lifestyle risks.” (Dr. Knutson)

What the news report says: Some “lumps and bumps” don’t need to be biopsied or further investigated. Veterinarians use the word “cancer” as a scare tactic in these situations.

What to say to clients
> “When you find a growth on your own skin, a bump in a breast or under the skin, we don’t say, ‘Let’s see how that turns out.’ We want to know what’s going on, whether it’s a fatty tumor and nothing to be alarmed about or something more.” (Dr. Paul)

> “The four most dangerous words in the English language are, ‘Let’s just watch it.’ I can never tell whether a growth is benign or malignant with just my eyes and fingers. And I’m gonna tell you, ‘cancer’ should be a scare word. It’s the No. 1 clinical cause of death in cats and dogs. One in four golden retrievers will die from cancer.” (Dr. Downing)

> “I’ve had cancer patients die after their first veterinarian told their owners repeatedly that a bump was nothing—without doing any testing. It’s only with analysis that you can put a name on that lump or bump. If your pet wasn’t born with it, we need to figure out what it is. We’re not going to think it’s cancer until we have the diagnosis. Until we know it’s cancer, we’ll consider it benign. And if we send for a cytology or a biopsy and receive that diagnosis, that is a cause of celebration.” (Dr. Knutson)

What the news report says: Veterinarians recommend dental cleanings and procedures that require anesthesia unnecessarily. They label just a little bit of tartar as dental disease or periodontal disease—and dental work is “the ultimate veterinary upsell.”

What to say to clients
> “If your healthcare goal for your pet to keep him or her alive as long as possible with a good quality of life, dental disease needs to be addressed early and often.” (Dr. Knutson)

> “Any amount of tartar is too much. When a veterinarian recommends a dental procedure, the horse has left the barn—there is dental disease present.” (Dr. Downing)

> “Dental disease is anything that’s not normal, from minor tartar or calculus all the way to horrible periodontal disease, with teeth wriggling around. Here is what I’m recommending and here is what may or may not happen if we go through with this treatment.” (Dr. Paul)

> “Eighty percent of a pet’s tooth is not visible to the eye. And half of what we can see in a pet’s mouth is impossible to assess in an awake animal. We need anesthesia to clean and assess periodontal disease, and we know better than ever how to lessen that risk as much as humanly possible.” (Dr. Downing)

> “It’s the way the mouth works, for people as well as cats and dogs. If you stopped brushing tonight, in a matter of weeks you’d have an accumulation of tartar, the start of periodontal disease, and inflammation and disease of the teeth and gums. Periodontal disease begins invisibly in a pocket between the tooth and the gum. Brushing helps stimulate those pockets and keeps them free of bacteria and food particles and dislodges the plaque that quickly forms tartar without brushing. If a pet isn’t having its teeth brushed, it will experience tartar buildup and disease.” (Dr. Downing)

> In cases where dental disease is a 1 or 2 on a scale of 1 to 10, consider saying this: “In a year or so, we’re going to have to do something about this. If you can do more dental care at home, like brushing or using a dental diet or chews, perhaps we can hold off even longer.” (Dr. Paul)

What the news report says: Veterinarians “push shots” by recommending unnecessary vaccines. Some veterinarians do not follow new three-year protocols and still give these every year.

What to say to clients
> “In deciding on a personalized vaccination protocol for your pet, we consider your pet’s unique lifestyle risks as well as local law, manufacturers’ directions and established guidelines from organizations like the American Veterinary Medical Association, the American Animal Hospital Association and the American Association of Feline Practitioners.” (all sources)

> “Vaccines are crucial. Vaccines explain why we now have cats and dogs who live into their late teens or even 20s. I’ve seen the life expectancy of the average Labrador retriever go from 9 to 15 or 16 years of age in my career.” (Dr. Downing)

What the news report says: Pet owners should remember that veterinary practices are also businesses and question veterinarians about the need for recommended products and services.

What to say to clients
> “I want you to come in with a list of questions, written down if possible. I want you to bring any articles you’ve read, and I want to sit down with you and talk about your healthcare goals for your pet. If your goal is to keep your pet alive as long as possible, we’ll talk about pet health insurance, individual risks and the importance of dental healthcare and weight management for longevity. And as your pet ages, we’ll talk about qualify of life.” (Dr. Knutson)

> “Yes, this is a business. We couldn’t provide our services without charging for them. This is what we recommend and why.” (Dr. Paul)